A structured, confidential way for employees to report harassment or discrimination.
Employees need to know how to raise a complaint and that it will be taken seriously. A clear form helps them give the details an investigation needs, without having to know legal terms.
The form is only one part of a process. Your policy should say who investigates, how the employee is protected from retaliation and how outcomes are communicated. Get professional advice when you set it up.
16 items. Use it on screen, or print it and fill it in by hand.
An employee reports repeated comments from a supervisor during night shifts. HR receives the form, acknowledges it the same day, moves the employee to a different supervisor for the review period at her request, interviews two witnesses, and communicates the outcome in writing.
Under Title VII and EEOC guidance, employers are expected to offer a complaint process, investigate promptly and take corrective action, and this form records each step with dates. It also captures any fear of retaliation at intake, since retaliation is a separate violation from the harassment itself.
| Employee | Sofia, dispatcher, night desk, Bayview Logistics, Oakland |
|---|---|
| Preferred contact | Personal cell, text first |
| What happened | Repeated comments about her body over the radio channel |
| Dates and people | Jan 8, 12 and 15, about 11 pm; driver Rick |
| Witness and evidence | Dispatcher Tom heard Jan 12; radio log times noted |
| Outcome wanted | Comments stop, no change to her shift |
| HR use | Received Jan 16 by Lena; outside investigator Paul; Rick routed to day dispatch |
The interim step moved Rick’s radio calls, not Sofia’s shift, because she asked to keep her schedule and moving the person who complained can look like retaliation. The radio log times give the investigator something to check beyond the two accounts.
You can accept anonymous reports, but they are harder to investigate.
Someone impartial and trained, sometimes an external investigator.
Information is shared only as needed for the investigation.
Retaliation against people who report is prohibited in many cases. Get legal advice on your obligations.
Yes. Accept it, acknowledge it and look into it, especially if the person they name still works for you. Former employees can also file a charge with the EEOC, generally within 180 days, or 300 days where a state or local agency enforces a similar law.
Yes. An employer can be responsible for harassment by customers, vendors or contractors if it knew or should have known and did not act. Use the same form and investigate, even though the options, such as banning a customer or changing a vendor contact, look different.
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Employees can fill in and sign forms like this in the EZTime app, and the signed copy lands in their digital employee file. A 14-day trial needs no credit card.